Table 1.
Comparison of studies using conventional risk prediction scores for RVF after LVAD implantation.
| Study (Author, Year, RVF Risk Score) |
Sample (n, Center, Device Type) |
Study Design | Definition of RVF (Rate) | RVF Risk Score Component | Results |
|---|---|---|---|---|---|
| -Matthews et al. [49] -2008 -Michigan RV risk score |
-197 patients -Single center -Mostly pulsatile |
-Retrospective analysis of a prospectively collected LVAD database -MLR |
35% -Need for postoperative IV inotrope support for >14 days -Inhaled NO for ≥48 h -Right-sided circulatory support -Hospital discharge on an inotrope |
-Vasopressor requirement → 4 -AST being ≥80 IU/l → 2 -Bilirubin being ≥2.0 mg/dL → 2.5 -Creatinine being ≥2.3 mg/dL → 3 -Renal replacement therapy → 3 |
-RVF developed in 80% of patients with a RVFRS of ≥5.5 -AUC of a RVFRS was 0.73 ± 0.04 |
| -Fitzpatrick et al. [50] -2008 -Penn RVAD risk score |
-266 patients -Single center -Mostly pulsatile |
-Retrospective -MLR |
37% -Preoperative RV dysfunction grade -None → mild → moderate → severe -As determined from the echocardiogram performed prior to LVAD insertion. |
18. (CI) + 18. (RVSWI) + 17. (creatinine) + 16. (previous cardiac surgery) + 16. (RV dysfunction) + 13. (systolic blood pressure) | -Score of ≥50 predicting the need for BiVAD -83% sensitivity and 80% specificity |
| -Drakos et al. [51] -2010 -Utah RV Risk Score |
-175 patients -Single center -Mostly pulsatile |
-Retrospective analysis of a prospectively collected LVAD database -MLR |
44% -Need for inhaled NO for >48 h -IV inotropes for >14 days RVAD implantation |
-DT → 3.5 -IABP → 4 -PVR of ≥4.3 WU → 4 -Inotropic dependency → 2.5 Beta-blocker → 2 Obesity → 2 |
-RVF% for risk score: ≤5.0 = 11% 5.5–8.0 = 37% 8.5–12.0 = 56% ≥12.5 = 83% -The AUC of the risk score was 0.743 ± 0.037 |
| -Kormos et al. [52] -2011 -Kormos (HM II) RVF risk score |
-484 patients -Multicentre -HM II |
-Retrospective -MLR |
20% -Requiring a RVAD -IV inotropes for >14 days after implantation -And/or inotropic support starting more than 14 days after implantation |
-CVP/PCWP of >0.63 -Need for preoperative ventilator support -BUN level of >39 mg/dL |
-Survival for patients without RVF at 180 days: 89% -Survival for patients with RVF at 180 days: 71% -AUC of the risk score was 0.68 |
| -Atluri et al. [53] -2013 -CRITT score |
-218 patients -Single center -HM II, pulsatile |
-Retrospective -MLR |
Criteria for initial BiVAD (rate 23%) Based upon ECHO parameters -RV contractility -Tricuspid regurgitation -Tricuspid annular motion |
-CVP of >15 mmHg → 4 -Severe RVD → 2 -Intubation preoperatively → 2.5 -Severe TR → mg/dL → 3 -Tachycardia of >100 bpm → 3 |
-93% of patients with a score of 1 or less underwent successful isolated LVAD -80% of patients with a score of 4 or higher required BiVAD -AUC of the risk score was 0.80 ± 0.04 |
| -Raina et al. [10] -2013 TTE Score |
-55 patients -Single center -Mostly HMII |
-Retrospective -MLR |
29% -Need for inotropes for ≥14 days. -Need for temporary RVAD Criteria for initial BiVAD (rate of 23%) -Severe RVD on TTE -Severe PHT with a PVR of >5 WU or RAP of >15 mmHg -Sustained VA causing hemodynamic compromise |
-LA volume index of <38 mL/m2 → 3 -RV FAC of <31% → 2 -RA pressure of >8 mm Hg → 2 |
-Score of ≥5 had a sensitivity of 63% and a specificity of 78% in predicting RVF |
| -Aissaoui et al. [54] -2015 -ARVADE score |
-42 patients -Single center -Mostly HM II, HeartWare HVAD, pulsatile |
-Prospective -MLR |
57% -Need for placement of a temporary RVAD -Use of inotropic agents for 14 days |
-Em/SLAT of ≥18.5 → 3 -RVEDD of ≥50 mm → 2 -INTERMACS level 1 → 1.5 |
-ARVADE score of >3.0 was predictive of post-LVAD RVF -Sensitivity of 89% and specificity of 74% |
| -Loforte et al. [55] -2018 -ALMA Score |
-258 patients -2 centers -Mostly HM II, HeartWare HVAD, HM 3 |
-Retrospective -MLR |
55% -Receiving short- or long-term RVAD despite maximal dosage of continuous inotropic support and NO ventilation |
-DT → 1 -PAPi < 2 → 1 -RV/LV ratio of >0.75 → 1 -RVSWi of <300 mmHg/mL/m2 → 1 -MELD-XI score of >17 → 1 |
-Rate of RVF was 9% for a score of <2 -Rate of RVF was 57% for a score of 2–3 -Rate of RVF was 100% for a score of 4–5 -A score of 3 points provided sensitivity and specificity higher than 80% |
| -Soliman et al. [56] -2018 -EUROMACS-RHF risk score |
-2988 Patients EUROMACS Database -Multicentre -Continuous-flow HeartWare HVAD, HM II, HM 3 |
-Retrospective analysis of the EUROMACS database -MLR |
21.7% -Receiving short- or long-term RVAD support -Continuous inotropic support for ≥14 days -NO ventilation for ≥48 h |
EUROMACS-RHF risk score/after adding CPB time -Need for ≥3 inotropic agents → 2.5/2 -INTERMACS class 1–3 → 2/2 -Severe RVD on the semiquantitative ECHO → 2/1. -RA/PCWP of >0.54 → 2/1 -Hemoglobin being ≤10 g/dL → 1/1.5 -CPB time being >100 min → -/1 |
-RHF risk ranged from 11% (low risk score of 0–2) to 43.1% (high risk score of >4 -AUC of the risk score was 0.75, 0.66, and 0.60 in the HM II, HeartWare HVAD, and HM 3 |
Abbreviations: RVF: right ventricular failure; LVAD: left ventricular assist device; MLR: multivariate logistic regression analysis; IV: intravenous; NO: nitric oxide; AST: aspartate aminotransferase; RVFRS: right ventricular failure risk score; AUC: area under the ROC curve; RVAD: right ventricular assist device; CI: cardiac index; RVSWI: right ventricular stroke work index; BiVAD: biventricular assist device; DT: destination therapy; IABP: intra-aortic balloon pump; PVR: pulmonary vascular resistance; HM II: HeartMate II; CVP: central venous pressure; PCWP: pulmonary capillary wedge pressure; BUN: blood urea nitrogen; ECHO: echocardiography; RVD: right ventricular dysfunction; TR: tricuspid regurgitation; TTE: transthoracic echocardiography; PHT: pulmonary hypertension; PVR: pulmonary vascular resistance; WU: wood unit; PAP: pulmonary artery pressure; VA: ventricular arrhythmia; LA: left atrium; RV FAC: right ventricular fractional area change; RA: right atrium; Em/SLAT: pulsed Doppler transmitral E wave/tissue Doppler lateral systolic velocity; RVEDD: right ventricular end-diastolic diameter; INTERMACS: Interagency Registry for Mechanically Assisted Circulatory Support; HM3: HeartMate 3; PAPi: pulmonary artery pulsatility index: MELD-XI: model for end-stage liver disease excluding the international normalized ratio; EUROMACS: European Registry for Patients with Mechanical Circulatory Support; CPB: cardiopulmonary bypass.